Despite recent advances in substance abuse interventions, a large percentage of patients entering residential treatment for substance use will drop out of treatment prematurely, and of the remaining, many will relapse soon after treatment completion. Previous work conducted by members of this proposal's research team indicates that an individual's ability to withstand psychological distress is a key factor necessary to maintain drug and alcohol abstinence. Based on these findings, the PI (Bornovalova) used an R36 dissertation grant from NIDA to develop a specific distress tolerance treatment called Skills for Improving Distress Intolerance (SIDI). This intervention features skills training in behavioral and acceptance strategies and intentional clinical exposure to emotional distress. Data showed that individuals receiving SIDI exhibited greater improvement in distress tolerance than those in two comparison groups (receiving treatment-as-usual and supportive counseling, respectively). However, it remains unclear whether SIDI reduces premature treatment termination and drug and alcohol relapse in the long-term. The objective of the proposed project is to provide a Phase II randomized controlled trial of SIDI. We will randomize 325 drug/alcohol users in a residential treatment facility that show low distress tolerance into 6 treatment sessions of SIDI or 6 sessions of Supportive Counseling (SC). We expect that compared to those in SC, those in SIDI will evidence a) increased distress tolerance, b) longer time to treatment dropout, and c) longer time to relapse and higher rates of abstinence at follow-ups at months 1, 3, 6, and 12. We expect that this program of research ultimately will result in the development of a specialized, efficacious intervention that can be broadly used in residential facilities with substance-abusing populations. PUBLIC HEALTH RELEVANCE: This project aims to validate a novel behavioral intervention that can be broadly used in residential facilities with substance-abusing populations. The development of a specialized, portable, and efficacious treatment for this high-risk population has clear public health value. Broad dissemination of this new intervention could help communities across the nation provide better and more cost-effective treatment and aftercare.